1407020936 NPI number — LABORATORIO CLINICO PASEO DEL RIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407020936 NPI number — LABORATORIO CLINICO PASEO DEL RIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO PASEO DEL RIO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407020936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4960
Provider Second Line Business Mailing Address:
PMB 497
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-7272
Provider Business Mailing Address Fax Number:
787-653-5111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERRA 183 KM 4.8
Provider Second Line Business Practice Location Address:
BO TOMAS DE CASTRO
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-7272
Provider Business Practice Location Address Fax Number:
787-653-5111
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOLANO
Authorized Official First Name:
YANIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGY
Authorized Official Telephone Number:
787-653-7272

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  40D2117212 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 40D1077716 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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